Han Yu, Zhang Changming, Feng Yani, An Xiaogang, Jiang Junbo, Chen Yang, Zha Dingjun, Qiu Jianhua
Department of Otolaryngology,Xijing Hospital,Air Force Medical University,Xi'an,710032,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Feb;34(2):100-105. doi: 10.13201/j.issn.1001-1781.2020.02.002.
A retrospective analysis of audiologic outcome and graft take rate on post-tympanoplasty with different middle ear mucosal conditions in wet ear. According to the characteristics of middle ear mucosal condition and residual eardrum, 80 cases with wet ear of chronic suppurative otitis media were divided into the hydrocele group, the swelling group and the granulation group. The factors in different groups, including gender, age, disease course, sides, size and location of perforations, destruction of ossicular chain and reconstruction methods were analyzed. Moreover, postoperative hearing improvement and graft take rate were compared among the three groups. There was no significant difference in gender, age, disease course, sides, size and location of perforations among the hydrocele group, the swelling group and the granulation group (>0.05). Overall, the postoperative average Air-Bone Gaps(ABG) were reduced in all wet ear patients after surgery (<0.01). The ABG was decreased from (25.5 ± 10.8) dB to(15.4 ± 9.4) dB in the hydrocele group, and decreased from (27.6 ± 8.7) dB to (15.2 ± 9.6) dB in the swelling group, and from (29.5 ± 7.7) dB to (17.2 ± 17.2) dB in the granulation group. The graft take rates were 90.0% in totally. There were no significant difference in graft take rates among the three groups, and 84.6% in the hydrocele group, 93.3% in the swelling group and 100.0% in the swelling group(>0.05). Wet ear is not an absolute contraindication of tympanoplasty for chronic suppurative otitis media. Whether there was effusion, swelling or granulomatous hyperplasia in the tympanoplasty, the patients'hearing improved significantly after tympanoplasty, and the healing rate of the tympanoplasty did not decrease. Further basic and clinical studies are needed to standardize the timing of wet ear surgery, clarify the operative contraindication and elucidate the pathophysiological mechanism of eardrum healing.
对湿性耳中不同中耳黏膜状况的鼓室成形术后听力结果及移植物成活率的回顾性分析。根据中耳黏膜状况及残余鼓膜的特点,将80例慢性化脓性中耳炎湿性耳患者分为积液组、肿胀组和肉芽组。分析不同组中的因素,包括性别、年龄、病程、患侧、穿孔大小和位置、听骨链破坏情况及重建方法。此外,比较三组术后听力改善情况及移植物成活率。积液组、肿胀组和肉芽组在性别、年龄、病程、患侧、穿孔大小和位置方面无显著差异(>0.05)。总体而言,所有湿性耳患者术后平均气骨导间距(ABG)均减小(<0.01)。积液组ABG从(25.5±10.8)dB降至(15.4±9.4)dB,肿胀组从(27.6±8.7)dB降至(15.2±9.6)dB,肉芽组从(29.5±7.7)dB降至(17.2±17.2)dB。移植物成活率总体为90.0%。三组移植物成活率无显著差异,积液组为84.6%,肿胀组为93.3%,肉芽组为100.0%(>0.05)。湿性耳并非慢性化脓性中耳炎鼓室成形术的绝对禁忌证。鼓室成形术中无论存在积液、肿胀还是肉芽肿性增生,患者鼓室成形术后听力均显著改善,且鼓室成形术愈合率未降低。需要进一步的基础和临床研究来规范湿性耳手术时机,明确手术禁忌证并阐明鼓膜愈合的病理生理机制。